The Royal Australasian College of Surgeons (RACS) has been the leading advocate for surgical standards, professionalism, and surgical education in Australia and Aotearoa New Zealand since 1927. RACS supports the ongoing development, maintenance of expertise, and lifelong learning that accompanies the surgical practice of over 8,300 specialist surgeons, 1,300 surgical trainees and Specialist International Medical Graduates.
RACS wishes to correct some of the claims made by the "Australasian College of Cosmetic Surgery & Medicine" (ACCSM), an unaccredited group with only a handful of specialist surgeons as members. ACCSM claims that the AMC has found a "deficit" in the training of cosmetic surgery in RACS' plastic and reconstructive surgery program. This is incorrect. The claim about a cosmetic surgery training "deficit" is based on a 2017 AMC accreditation report, which raised a concern about the exposure of RACS surgical trainees to aesthetic surgery in the Plastic and Reconstructive Surgery program. This issue was caused by the fact that, at the time, Commonwealth government funding for several trainee positions in private hospitals was under threat. Subsequently, all but one training position secured alternative funding, and no compromise to training in aesthetic surgery occurred. The concern was fully addressed and resolved, and any suggestion that the concern remains current is inaccurate. RACS' most recent AMC accreditation report (2021) made no mention of a deficit.
The Australian Medical Council (AMC) and the Medical Council of New Zealand (MCNZ) accredit specialist surgical training programs across ten different surgical specialties, nine of which RACS is the sole accredited training provider for Cardiothoracic Surgery, General Surgery, Neurosurgery, Orthopaedic Surgery, Otolaryngology Head and Neck Surgery, Paediatric Surgery, Plastic and Reconstructive Surgery, Urology, and Vascular Surgery.
Other medical practitioners who will be recognised as being able to use the title ‘surgeon’ under new legislation include those registered in the fields of practice /specialties of Ophthalmology, Obstetrics and Gynaecology, and Oral and Maxillofacial Surgery. RANCZO, RANZCOG and RACDS colleges are AMC or MCNZ accredited to provide training for these specialties/field of practice.
RACS wishes to correct any imputation that RACS' Fellows are not trained to conduct cosmetic surgery safely. In the public mind, cosmetic surgery is often thought of as encompassing a discrete collection of procedures, albeit very different ones, such as breast enhancements and rhinoplasty. Yet, cosmetic objectives - the restoration or enhancement of aesthetic form and texture - is an important, if not always primary, objective of all surgery. Whether a surgeon is undertaking functional surgery or tumour surgery, there is always an aesthetic component to the operation, and the surgeon will always seek the best aesthetic outcome possible for the patient.
To achieve this expertise, all of RACS' surgical training programs are five to six years in duration full-time. Usually, trainees have already spent several years as doctors in operating theatres before they are accepted into these programs.
As noted, there is almost always an aesthetic component to an operation. However, there are several surgical fields for which aesthetic outcomes are usually a core objective of procedures. These include General Surgery, Gynaecology, Otolaryngology, Ophthalmology, Paediatric Surgery, Plastic Surgery, and Urology (Urological Surgery).
RACS is the accredited AMC provider for specialist training in all these areas of practice, except Obstetrics and Gynaecology, and Ophthalmology, which is provided by RANZCOG and RANZCO, respectively. Different fields of specialty practice training programs usually focus on different parts of the human anatomy. For example, nose surgery is a focus in the training program for Otolaryngology. Rhinoplasties are often sought for cosmetic purposes.
The specialty of plastic surgery is a technique and process surgical specialty with a relatively broad scope. RACS' plastic surgery training program includes topics on many procedures in the domain of cosmetic surgery, such as breast procedures, facial surgery, genital surgery, laser surgery, injectables, and body contouring surgery. Other RACS surgical specialty training programs also cover various of these procedures, as well as other procedures.
RACS has expressed concerns about the recently approved ‘endorsement for cosmetic surgery’. RACS’ main concern is that it remains unclear what the standard of any accredited training program enabling endorsement will be.
In the simplest terms it is unclear whether an accredited training program will be five-weeks or five-years long.
RACS is of the strong view that any applications for accreditation as providers of cosmetic surgery training enabling endorsement should be open for comment by stakeholders.
RACS will be keen to scrutinise any proposed training programs, particularly any proposed by groups which do not traditionally have a fellowship made up of specialist surgeons, such as ACCSM.